20
for initial 2 years of life. However, WHO growth standards are available for
only 0–5 years of age, and later monitoring is recommended with region-
specific growth charts. In addition, the use of these growth charts may result in
overdiagnosis of short stature, especially in children from developing countries.
WHO also derived a cross-sectional growth chart in 2007, which is a “growth
reference chart” for children aged 5–19 years.- Which growth chart should be used for Indian children?
The growth charts based on data from Indian population include Agarwal
(1992, 1994), IAP (2007), Khadilkar (2009), Marwaha (2011), and revised IAP
(2015) growth charts. Agarwal and Khadilkar charts were derived from school-
going children belonging to affluent families, whereas Marwaha chart included
school-going children from both upper and lower socioeconomic status. Data
obtained from Agarwal et al. was used to derive IAP growth chart (2007),
whereas data from nine studies in apparently healthy children from upper and
middle socioeconomic class was used to derive revised IAP growth chart
(2015). The revised IAP growth chart was constructed after exclusion of over-
weight children (weight for height above +2 SD score). Agarwal charts are
nearly two decades old; hence its use is limited as it does not reflect the secular
trend of height over this period. Khadilkar and Marwaha growth charts are rela-
tively recent; however, the use of these charts results in underdiagnosis of obe-
sity. Revised IAP growth chart (2015) addresses most of the limitations of
previous growth charts. Indian Academy of Pediatrics recommends WHO
growth chart (2006) for children aged 0–5 years and revised IAP growth chart
(2015) from 5 to 18 years. It is pertinent to use the same growth chart during
follow-up of a child.- What is the importance of simultaneous estimation of height and weight in the
evaluation of short stature?
During the growth of a child, increase in height and weight occurs in concor-
dance with each other. Therefore, the interpretation of linear growth in relation
to weight provides clue for the differential diagnosis of short stature. In a growth
chart, the age that corresponds to child’s height at 50th percentile is height age of
the child, whereas the age that corresponds to child’s weight at 50th percentile is
the weight age. If a child with short stature is “overweight for height” (weight
age > height age), then the cause is usually an endocrine disorder like Cushing’s
syndrome, growth hormone deficiency, hypothyroidism, or Prader–Willi syn-
drome. If the child with short stature is “underweight for height” (weight age <
height age), then systemic causes like nutritional deficiencies, celiac disease,
and chronic systemic disorders need to be evaluated (Fig. 1.9a, b).
1 Disorders of Growth and Development: Clinical Perspectives